Origins of Nephrology –
Middle Ages, Renaissance, Byzantium
Am J Nephrol 2002;22:172–179
Use of Natural Substances in the
Treatment of Renal Stones and Other
Urinary Disorders in the Medieval Levant
Efraim Lev a Eran Dolev b
a Department of Eretz Israel Studies, University of Haifa, and b School of Medicine, Tel-Aviv University,
Tel-Aviv, Israel
Key Words
Natural substances W Renal stones W Urinary disorders W
Middle ages W Levant W History of nephrology
Abstract
Urinary disorders were common in the ancient world,
especially in the Mediterranean region. In semi-arid
zones and countries with unreliable water sources, renal
stones and other urinary problems occur with greater
frequency. A lack of water and correspondingly high lev-
els of calcium saturation are among the main reasons for
the formation of calcium sediments in the urinary tract,
and it is hardly surprising, therefore, that many genera-
tions of physicians and healers have been called upon to
treat these disorders, or at least alleviate the pain associ-
ated with them. Down the ages, many natural sub-
stances have been used for this purpose. This article
focuses on 62 plants, 9 animal-based remedies, 1 miner-
al preparation and 4 medicinal substances of different or
uncertain origin, traced in a recent survey of relevant his-
torical literature (both medical and non-medical). Many
of these materials, used to treat urinary disorders in the
Levant between the 8th and the 18th centuries, had al-
ready been in use since the classical period, and several
are still used today in traditional medicine.
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Introduction
The search for medical substances developed alongside
humanity’s basic quest for food. Early humans gained
their knowledge of the natural substances they collected
by trial and error, and this body of knowledge expanded
in tandem with the technological, agricultural, industrial
and scientific evolution of the species. Documentary evi-
dence has revealed that the issue of medicine and medical
substances was already of central importance to early civ-
ilizations such as those in Egypt [1] and Mesopotamia [2].
Similarly, ancient Greek culture regarded the study of
medicine as an important field of human enquiry, and
great Hellenistic scholars – Hippocrates and Aristotle in
particular began to lay the philosophical and scientific
foundations of modern pharmacology. The Roman scien-
tists and physicians, who inherited this legacy, included
and expanded upon the knowledge it contained in their
own medical and pharmacological literature, producing
herbals and materia medica that were used across the
Empire.
Recent investigations have uncovered several plants
employed by Roman physicians to treat renal disorders:
12 positively identified, of hundreds, in Dioscorides’ Ma-
teria Medica (1st century CE) [3] and 130 of the 900
plants described in the Naturalis Historia of Pliny the
Elder (23–79 CE) [4–6].
The present article is intended to conclude our re-
search into medical substances used by inhabitants of the
Efraim Lev
Department of Eretz Israel Studies
University of Haifa
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Haifa (Israel)
Tel. +972 4 8240 949, Fax +972 4 8240 959, E-Mail levefr@zahar.ret.il
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medieval Levant. A systematic historical survey has been
carried out using primary sources from a number of fields,
including medical and agricultural treatises, travelers’ ac-
counts, geographic, commercial and historiographic litera-
ture, as well as Moslem and Christian archives and the
Jewish Genizha fragments. Secondary sources used include
medieval books in the fields of chemistry and medicine,
alongside medical dictionaries and encyclopedias [7].
History of Nephrological and Urinal Disorders
in the Levant
The formation of urinary stones is a common metabol-
ic disorder, mainly affecting people living in what are
defined as ‘stone belts’. The Mediterranean region is one
such ‘stone belt’, where the problem of renal stones,
known since ancient times, is still prevalent. There are a
number of key historical pointers that enable us to plot a
chronology of the disorder, but perhaps the earliest evi-
dence for urinary stones dates from around 8000 BCE: a
stone found in the pelvis of a mummified male in a tomb
in Egypt [8]. Subsequently, The Hippocratic Oath, dating
from about the 5th century BCE, includes a special para-
graph referring to the hazards of curing urinary stones sur-
gically. The physician Galen (129–200 CE) mentions the
use of the ‘Judaean Stone ... produced in Syria Palestina ...
against stones of the bladder’ [9]. Similarly, the Roman
Emperor, Septimius Severus (193–211 CE), used to visit
the Hissarya baths in Bulgaria every spring to receive
treatment for his renal stones [10]. Jewish Sages described
urinary calculi and offered remedies for their treatment in
the Talmud, compiled between the fourth and fifth centu-
ry CE: for example, in Yebamoth (folio 64b), the Talmud
tells us that Rabbi Acha ben Jacob once suffered from a
painful or difficult urinary condition, finding it difficult
to pass water, probably due to a uratic stone.
Uroscopy, the diagnosis of disease through the exami-
nation of a patient’s urine, was a very common medical
procedure in the Byzantine Empire [11]. Its development
largely reflected the increasing need for accurate diag-
noses of renal conditions, especially stones, and the pro-
cess was based on comparative examination of urine col-
or. Naturally, physicians and healers down the ages have
attempted to prevent, alleviate and cure this often ex-
tremely painful medical condition. Diuresis has always
been a keystone in the treatment of renal colic and urinary
stones in general, and thus the most important medical
approach to the condition was to find substances which
could produce a diuretic effect [12].
Use of Natural Substances in the Treatment
of Renal Stones
Analysis of Natural Medical Substances in Use
in the Medieval Levant
According to our historical survey, the inventory of
medical substances in use in the medieval Levant consisted
of 286 materials. Two hundred and thirty-four of these
(81.8%) were plant-based, while 27 (9.5%) derived from
animal sources. The 15 minerals (5.2%) represent a negligi-
ble proportion of the inventory, as do the 10 substances
(3.5%) from different or uncertain origin. The vast majori-
ty of the materials originated in the Levant itself (88.1%).
Others were imported from different countries, mainly
from remote areas of Asia and Africa [7]. It should also be
noted that the historical evidence suggests a flourishing
export market for medical substances from the region, with
84 documented materials being regularly exported out of
the Levant, mainly to Egypt and Europe [13].
Use of Natural Substances of Animal Origin to
Cure Urinary Disorders
Animals and animal organs form part of the inventory
of medical substances belonging to the earliest civiliza-
tions in Egypt [1] and Mesopotamia [2]. For example,
physicians in Mesopotamia were already using coral for
renal stone therapy in distant antiquity [14]. Indeed,
medicinal applications employing animals and animal
biproducts are well documented throughout history, and
can still be found in present-day folk medicine. Our
research revealed 9 substances of animal origin used to
combat urinary obstructions and promote renal disease
therapy in the medieval Levant (table 1).
Nine of 27 medical materials of animal origin in use in
the medieval Levant [7] were used to treat renal diseases.
It is suspected that some of the substances, such as egg-
shells, were used in accordance with the doctrine of Signa-
ture [15]. However, more diverting is the fact that some of
these materials are still used in folk medicine: in Pakistan
for example, fireflies are used to treat kidney and bladder
stones; mouse excrement, lice and the stinkbugs are used
to clear urinary obstructions; and scorpion ash is em-
ployed to clean the urinary system [16].
From a geographical and commercial perspective, it
should be noted that all the animals are local, and all but
one, the hen, could be found in the wild, with four species
(hen, mouse, louse and stinkbug) existing as part of the
human ecosystem. Perhaps the most startling treatment
for urinary obstruction involved the louse: medieval phy-
sicians actually placed live animals at the opening of the
Am J Nephrol 2002;22:172–179 173
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Table 1. Medical substances of animal origin used in renal disease therapy
No. Scientific name Common name
1 Lampyris nerusa Firefly, glow-worm
2 Chlamydotis undulara Bustard
3 Ficedula sp. Flycatcher
4 Pediculus humanus Louse
5 Climex lectularius Stinkbug
6 Mus musculus praetextus House mouse
7 Leiurus quinquestriatus hebraeus Scorpion
8 Lumbricidae sp. Earthworm
9 Gallus gallus domesticus Hen
urethral tract and forced them to enter the tract and move
towards the bladder. This medical procedure, which was
probably very painful, helped to clear the obstruction.
Haim Vital, a Jewish scholar and a physician (16–17th
century), gives a detailed description of this treatment in
his writings [17]. Vital wrote that, in the event of being
unable to find any lice, a physician might also perform the
procedure with a stinkbug. A similar description was giv-
en by the 13th-century Andalusian physician Ibn al-Bay-
tar [18].
Medical Substances Derived from Minerals
Minerals have played an important part in the evolu-
tion of medical substances from the earliest times. Materi-
als derived from minerals formed part of the Egyptian
and Mesopotamian materia medica, and through classical
medical literature and the pharmacology of the various
medieval cultures to present-day traditional medicine,
minerals have been components in many effective reme-
dies [19]. Our historical survey of medical literature in the
Middle Ages revealed that of the 15 minerals with medi-
cal applications in the medieval Levant [7], only one was
found to be useful for renal disease therapy, the so-called
‘Jew’s stone’ (also known as Lapis Judaicus). ‘Jew’s stone’
had been used as a diuretic, and to treat urinary obstruc-
tion and clear stones in the urinary system, the bladder
and the kidneys since Roman times [Dioscorides V.155;
Galen IX, 2:5; Ibn al-Baytar 1874 II:5; Ben Maimon
1961,21:65; Antaki 1935:118].
174 Am J Nephrol 2002;22:172–179
78
Medical uses References
Clearing kidney stones Antaki 1935:115
Clearing kidney stones Antaki 1935:115
Clearing kidney stones Antaki 1935:141–142
Clear urinary obstruction Benajahu 1987:95
Urinary obstruction, clearing kidney Dioscorides II.36; Ibn al-Baytar 1874;III:
stones 162–163; Antaki 1935:81–82;
Benajahu 1987:95
Mouse excrement was used to clear Antaki 1935:246–247
urinary obstruction
Clear urinary obstruction (stones) Ben Maimon 1961;22:10
Clearing urinary obstruction Dioscorides II.72; Ibn al-Baytar 1874;II:57
Eggshells were used to treat urinary Benajahu 1987:92
obstruction and to clear stones
‘Jew’s stones’ are actually the petrified spines of the sea
urchin (Cidaris sp.), found in the geological stratum of the
Jurassic period (100 million years ago). The use of Lapis
Judaicus was first mentioned by Dioscorides. Subse-
quently, most medieval physicians quoted this source and
through the ages it received the Arabic name Hajar al-
Yahudi (Jew’s stone). It is suspected that the ‘Jew’s stone’
was used universally in this application according to the
Doctrine of Signature [15]. The petrified spines are still
sold and used in present-day traditional medicine to clear
urinary obstructions (stones), notably among Babylonian
Jews [20] and among a number of ethnic minority groups
in Israel [19], in the Kingdom of Jordan [21] and in Paki-
stan [22].
Substances Derived from Different or Multiple
Origins
These materials do not meet the strict criteria charac-
terizing substances of plant, animal and mineral origin.
They are perhaps from more than one source, or they are
processed and therefore it is difficult to determine exact
derivation. These materials are presented in table 2.
The four substances presented in table 2 were readily
available in the past, and each had a clear medical appli-
cation. Among these four, two were found locally and two
were imported. Excluding Mumiya (which became a rare
substance in Mediterranean market places due, largely, to
changing attitudes to death and the dead in modern soci-
ety), these substances were used right up until the present
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Table 2. Substances derived from different or multiple origins
No. Common name Description
1 Glasswort, Barilla Beech and salty plant ashes
2 Mumiya (1) Exudation of bituminous substances.
(2) Embalmed bodies from Egyptian tombs
3 Flower water Perfume made out of flowers such as
sour orange
4 Cedar tar Resin of cedars, pines, junipers, etc.
day. Indeed, flower water and cedar tar are used inten-
sively in modern Turkey and are sold in most of the mar-
ket places in the Middle East [19, 21].
Plant-Based Remedies for Renal Stones and
Other Urinary Disorders
The majority of medicinal substances have always
been plant-based. The remains of medicinal plants have
been found during the archeological excavation of prehis-
toric sites, and their use is recorded in some of our oldest
surviving literatures. The range of ancient cultures that
documented their use of plants as medicines is unique:
plants were the most important ingredients for remedies
in the Chinese Tsao Pen [23], the Egyptian Ebers papyrus
[1], the National Mesopotamian Library of Ashurbanipal
[2], and in the writings of classical scholars such as Hip-
pocrates [24], Dioscorides [25] and Pliny [26]. Research
into the relevant medieval literature has uncovered 62
plants, used as medicines in the Middle Ages, which were
specifically employed to treat renal disease and obstruc-
tions. These plants are presented in table 3.
A closer examination of table 3 shows the interesting
composition of this inventory of medicinal plants. The list
comprises wild (30) as well as cultivated species (33), a
few plants grew in the wild but were also cultivated, and
includes many plants commonly used as spices. The over-
whelming majority (55) are of local origin (both wild and
cultivated) and only a few (7) were imported to the Levant
for medical purposes or for food – though a few locally
available plant species were also sometimes imported in
response to market demand. According to these data then,
it is clear that the plants used by both the inhabitants and
the physicians of the time to treat renal diseases were
mainly local in origin. When cross-referenced with other
Use of Natural Substances in the Treatment
of Renal Stones
Medical uses References
Diuretic, clear obstruction Ibn al-Baytar 1874;I:37–38;
Qazwini 1981:239
Clearing urinary obstructions, treating Razi 1967:496–499;
bladder abscesses Ibn al-Baytar 1874;IV:169–170
Treatment of urinary obstructions and Antaki 1935:289
stones
Diuretic, clear urinary obstructions and Ben Maimon 1961;21:65
stones
information gathered during the course of research, we
can also deduce that at least one of the plants, the Com-
mon Gromwell (Lithospermum officinale), was used ac-
cording to the Doctrine of Signature [15].
Most of the plants in the list – we might single out par-
ticularly well-known diuretic herbs such as Petroselinum
sativum – continue to be used as popular remedies due to
their effective therapeutic qualities in the treatment of
renal problems [19, 27]. Other plants, such as Urtica
urens, are equally familiar to modern homeopathy. Botan-
ical analysis demonstrates that among the plant families
most conspicuous in their contribution to the medical
inventory we find the following: Liliaceae, Compositae,
Labiatae, Umbelliferae, Rosaceae, Cruciferea and Papi-
loniaceae (each represented by 3–6 species). Incredibly,
these varieties are still important in present-day pharma-
cology. Thirty more plant families are represented by one
or two species each.
Comparison of table 3 with the list of plants used to
treat renal conditions according to the writings of Pliny
the Elder [5], shows that 24 species are common to both
lists. These plants are of great interest since their applica-
tion in medicines combating renal disorders is cross-cul-
tural and goes well beyond tenuous geographical and
chronological links. On the other hand, paradoxically,
only 3 of 12 plants prescribed by Dioscorides [3] for such
conditions, were similarly recommended by Levantine
physicians (and therefore find their way into table 3).
Nevertheless, this investigation confirms the strong im-
pact that classical medical theory and practice had on the
medieval physicians of the Levant. Most of the plants in
table 3 can be found in inventories of traditional remedies
used to treat renal disease in different cultures across the
Middle East, Arabia, North Africa and Turkey [28].
Am J Nephrol 2002;22:172–179 175
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Table 3. Plant-based remedies for renal stones and other urinary disorders

No. Scientific name Common name Medical uses References

1 Adiantum capillus-verneris Maidenhair Plant – diuretic, clear stones in the kidney, Dioscorides IV:136; Ibn al-Baytar 1874;I:164;
bladder and urinary tract Benajahu 1987:96
2 Agrimonia eupatoria Common agrimony Plant – treat kidney disease, clear urinary Assaph 1967;4:218; Antaki 1935:242
obstructions and stones
3 Allium cepa Onion Bulb skin – diuretic, clear obstructions of Benajahu 1987:94; Antaki 1935:76
urinary tract
4 Aloe vera Aloe Plant juice – clear urinary obstructions Antaki 1935:222
5 Amomum sp. Amomum Plant – clear stones and obstructions of Antaki 1935:127–128
kidney and urinary tract
6 Anthemis sp. Chamomile Plant – diuretic, clear stones and obstructions Dioscorides III:154; Ibn al-Baytar 1874;I:48–49;
and cure diseases and inflammation of the Antaki 1935:53–54
kidney
7 Apium graveolens Celery Plant – diuretic, clear stones and obstructions Dioscorides III:74–75; Assaph 1967;4:414;
of urinary tract, cure kidney diseases Antaki 1935:270
8 Aristolachia sp. Birthwart Plant – diuretic, cure kidney diseases, clear Assaph 1967;4:404, 420; Antaki 1935:177
kidney stones
9 Artemsia deacunulus Tarragon Plant – clear obstructions and stones of kidney Assaph 1967;4:411; Antaki 1935:232
and urinary tract
10 Artemsia judaica Judean wormwood Herb – clear obstructions and stones of kidney Antaki 1935:339
and urinary tract
11 Asparagus officinalis Asparagus Plant – cure kidney and urinary disorders Dioscorides II:152; Ben Maimon 1961;21:65, 68;
Seed – strengthen the kidney Meyerhof and Sobhy 1932–40:542–544;
Root – diuretic, clear stones in bladder and Benajahu 1987:95
urinary tract
12 Astragalus gummifer Tragacanth gum Resin – diuretic, clear kidney stones, treat Dioscorides III:23; Assaph 1967; 4:415;
kidney pain Ibn al-Baytar 1874; IV:52–53
13 Atriplex halimus Saltbush shrub Plant – clear stones and obstructions of Antaki 1935:324
urinary tract
14 Bunium paucifolium Caraway Seed – clear kidney stones Ibn al-Baytar 1874;I:5; Antaki 1935:112
15 Capparis spinosa Caper Plant and root – diuretic, clear stones and Dioscorides II:204; Assaph 1967;4:391;
obstructions and cure diseases of the kidney Ibn al-Baytar 1874; IV:45–48;
Ben Maimon 1961;19:13; Antaki 1935:266
16 Cassia fistula Purging cassia Fruit – clear stones and obstructions of Benajahu 1987;92,94
urinary tract and the bladder
17 Cerasus sp. Cherry Resin and fruit – clear stones and obstructions Dioscorides I:157; Antaki 1935:255–256
of urinary tract
18 Cinnamomum camphora Camphor Oil – cool the kidney, cure kidney diseases, Ibn al-Baytar 1874;IV:42–44
clear bladder stones
19 Citrullus vulgaris Watermelon Fruits – diuretic Antaki 1935:79; Benajahu 1987:91
Seeds – clear urinary obstruction and stones
20 Commiphora opobalsamum Balsam Resin – diuretic, cure kidney and urinary Assaph 1967;4:398; Ibn Sina 1877:265;
diseases, clear kidney and urinary stone Ibn Rushd 1939:157; Qazwini 1981:218
21 Convolulus scammonia Syrian bindweed Root juice – diuretic, clear obstructions Ibn al-Baytar 1874;III:17–19; Antaki 1935:193–194
22 Croton tiglium Purging tiglium Plant – clear kidney stones Antaki 1935:154
23 Crucus sativus Safran Stigma and root – diuretic, clear stones and Dioscorides I.25,26; Assaph 1967;4:397;
obstructions of urinary tract, cure kidney Levey 1959:77, 105; Qazwini 1981:250;
diseases Benajahu 1987:94
24 Daucus carota Carrot Root – diuretic, cure kidney pain and clear Assaph 1967;4:409; Ibn al-Baytar 1874;IV:119;
obstructions and stones in urinary tract Antaki 1935:105–106
25 Dorema ammoniacum Ammoniacum Resin – treat kidney diseases, clear stones Antaki 1935:46
in urinary tract

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Table 3 (continued)

No. Scientific name Common name Medical uses References

26 Dryopteris pallida Shield wood fern Plant – clear obstruction Ibn al-Baytar 1874;III:7
27 Ecbalium elaterium Squirting cucumber Plant – clear stones and obstructions of Antaki 1935:254–255
urinary tract
28 Eruca sativa Garden rocket Plant – diuretic, clear obstructions of urinary Assaph 1967;4:406; Ibn al-Baytar 1874;I:160–161;
tract Antaki 1935:105
29 Gossypium herbaceum Cotton Seed – clear stones and obstructions of urinary Benajahu 1987:92
tract
30 Jasminum sp. Jasmines Plant and oil – diuretic, clear obstructions Antaki 1935:241; Qazwini 1981:237
31 Juglans regia Wallnut Oil – treat kidney disease Levey 1966:56; Ibn al-Baytar 1874;I:173–175;
Seed – clear urinary obstructions and stones Antaki 1935:109–110
Unripe fruit – diuretic
32 Laurus nobilis True laural Leaves – diuretic, clear stones and obstructions Assaph 1967;4:399; Levey 1966:158;
of the urinary tract and kidney Ben Maimon 1961;21:65; Antaki 1935:242–243
Oil – warm the kidney
33 Lithospermum officinale Common gromwell Plant – diuretic, clear stones and obstructions Dioscorides III:158; Antaki 1935:262
of urinary tract
34 Majorana hortensis Majoram Herb – diuretic, clear kidney and urinary Assaph 1967;IV:408; Qazwini 1981:254;
obstructions and stones Antaki 1935:292
35 Melia azedarach Nim Fruits – clear kidney and urinary stones, Ibn al-Baytar 1874;I:22–23; Antaki 1935:9
diuretic
36 Melilotus albus medicus Sweet clover Plant – diuretic, clear stones and obstructions Dioscorides III:48; Assaph 1967;4:403–415;
of kidney Antaki 1935:55
37 Morus nigra Black mulberry Fruit – clear obstruction cure kidney diseases Antaki 1935:98
38 Myristica fragrans Nutmeg Seed – clear obstructions of urinary tract Antaki 1935:110–111
39 Myrtus communis Myrtle Plant – clear kidney stones Antaki 1935:43
40 Nardostachys hatamansi Spikenard Root – warm the kidney, clear stones and Assaph 1967;4:391–392; Levey 1966:56;
obstructions of urinary tract Ibn al-Baytar 1874;III:36–38
Oil – treat kidney diseases
41 Ocimum basilicum Sweet basil Seed – clear obstructions of urinary tract Qazwini 1981:240
42 Olea europea Olive Oil – diuretic, clear stones and obstructions of Antaki 1935:183–184
kidney and urinary tract, cure kidney diseases
43 Petroselinum sativum Parsley Herb – diuretic, clear stones and obstructions Dioscorides III:76; Assaph 1967;4:419;
of urinary tract and kidney, treat kidney pain Ben Maimon 1961;21:65; Benajahu 1987:91
44 Pimpinella anisum Anise Seed – diuretic, clear stones and obstructions Levey 1966:128; Hamarneh 1978; Antaki 1935:59
of urinary tracts
45 Polypodium (Aspidium) Serapias Plant – diuretic, clear stones and obstructions Ben Maimon 1961;9:70; Antaki 1935:284
lochitis of urinary tract
46 Portulaca oleracea Purslane Plant – clear obstructions and stones from Ibn al-Baytar 1874;I:102–103
urinary tract and kidney
47 Prunus amygdalus Almond tree Seed, oil, resin – clear stones from the kidney Dioscorides I:176; Assaph 1967;4:399;
and urinary tract Ibn al-Baytar 1874;III:86; Benajahu 1987:95
Fruit peel – clear bladder stones and
obstruction of the urinary system
48 Prunus domestica Plum Resin – clear kidney stones Ibn al-Baytar 1874;III:86; Antaki 1935:38–39
Fruit – open obstructions
49 Prunus persica Peach Seed and fruit – clear obstructions and stones Antaki 1935:38; Benajahu 1987:91, 95
in urinary tract
50 Quercus callprinos Oak Acorn – diuretic, clear kidney stones Antaki 1935:83; Lewis 1953
51 Raphanus sativus Radish Leaf juice – clear kidney stones Benajahu 1987:91–92, 94

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Table 3 (continued)

No. Scientific name Common name Medical uses References

52 Ricinus communis Castor oil plant Leaf – clear kidney stones Dioscorides II:104; Benajahu 1987:93
Oil – clear obstructions of urinary tract
53 Rosa canina Wild dog rose Flower water – clear stones and obstructions Benajahu 1987:91
of urinary tract
54 Rubia tinctorum Common madder Root – diuretic, clear obstructions Dioscorides III:160; Ibn al-Baytar 1874;III:169
55 Ruscus aculeatus Butcher’s broom Plant – diuretic, clear stones and obstructions, Dioscorides IV: 149; Ibn al-Baytar 1874;I:30
and cure diseases of urinary tract, bladder and
kidney
56 Sesamum indicum Oriental sesame Oil (seed) – diuretic, clear stones and Benajahu 1987:92, 99
obstructions of urinary tract
57 Solanum nigrum Black nightshde Plant – clear obstructions, cure kidney and Antaki 1935:240–241
bladder swelling
58 Teucrium capitatum Cat thyme Plant – diuretic, clear stones and obstructions Meyerhof and Sobhy 1932–40:423–425;
of urinary tract Antaki 1935:106
59 Urginea maritima Sea squil Bulb – clear stones and obstructions of kidney Dioscorides II:202; Antaki 1935:76–77
and urinary tract
60 Urtica sp. Nettle Leaves and seeds – diuretic, clear stones and Assaph 1967;4:418; Ben Maimon 1961;9:70
obstructions of urinary tract and kidney
61 Vicia ervilia Bitter vetch Seed – treat blood in the urine, clear Assaph 1967;4:172; Ibn al-Baytar 1874;IV:63–64
obstructions of urinary tract
62 Viscum sp. Mistletoe Plant – diuretic, used to clear stones and Dioscorides III:103; Antaki 1935:85–86
obstructions of urinary tract

Data Analysis Secondly, located at the junction between three conti-

Analysis of the data reveals that 76 materials – about a
quarter of the medicinal substances used by the inhabit-
ants of the medieval Levant – were used to treat renal dis-
eases (though they were not all used exclusively for this
purpose). This fact underlines the high occurrence of such
conditions in the area during the Middle Ages. Interest-
ingly, the ratio between substance categories in the list of
materials used to treat renal stones and urinary disorders
described in this article is very similar to that found in the
overall list of medical substances in use in the medieval
Levant: 62 plant-based substances, an overwhelming ma-
jority (81.6%), 9 animal materials (11.8), 1 mineral (1.3%)
and 4 samples derived from other substances (5.3%) [7].
The geographical location of the Levant influences the
medieval inventory of substances used for the treatment
of renal diseases in two primary ways: firstly, the abun-
dant flora and fauna in the region, its diverse topography,
its varying regional climates, and the existence of unique
environments such as the rift valley, all contributed to the
wealth and variety of the inventory of medical substances.
nents, the Levant’s position made it an important cultural
and commercial crossroads from the outset, linking east
and west. Consequently, the region was exposed to the
many diverse medical substances that arrived both as a
result of direct trade, and as a by-product of occupation
and conquest by other peoples over the centuries.
Conclusion
Renal diseases and urinary tract obstructions are still a
major health issue around the Mediterranean. It seems
that not much has changes since Hippocrates wrote his
famous oath and identified one of the ancient world’s key
medical problems: inhabitants of the area still demon-
strate many of the same symptoms and suffer from the
same disorders. Whilst there are a number of effective
modern treatments for renal and urinary conditions, there
is a great need for new, natural medicines – tried and
tested drugs that can bring relief without detrimental side
affects. If there is one overarching conclusion to draw

178 Am J Nephrol 2002;22:172–179 Lev/Dolev

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from the evidence presented in this article, it is that com-
prehensive, fully funded research into some of the sub-
stances (mainly those of plant origin) used for hundreds of
years by classical and medieval physicians, could lead to
the development of remedies that would fulfil that need.
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The authors would like to thank the British Council (Chevining),
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